Rudolf Fahlbusch

Cytotoxic Effects of Alkyl-Lysophospholipids in Human Brain Tumor Cells

The cytostatic activity of alkyl-lysophospholipids (ALP) was investigated in vitro with cells from 2 astrocytomas, 2 glioblastomas and a meningioma. In all lines the incorporation of [3H]thymidine into the tumor cells was inhibited by ALP. This effect was dependent on the ALP dose and incubation time. Incorporation rates were less than 5-10% of the control rates after an incubation time of more than 48 h with the ALP compound at a concentration of 20 micrograms/ml. 2-lysophosphatidylcholine, the ester-linked lysophospholipid, did not reveal any cytostatic effects. As a morphological criterion for severe cell damage, the trypan blue dye exclusion test was performed. Results were closely correlated with those of the thymidine incorporation inhibition assay. Further morphological evidence for actual damage of the tumor cell, caused by ALP incubation, was obtained by light microscopy of cytocentrifuge preparations and scanning electron microscopy. Membrane defects of tumor cells incubated with ALP were observed both in light and scanning electron microscopy, whereas untreated control cells remained intact. In cytocentrifuge smears of tumor cells, karyorrhexis occurred after 24 h of ALP treatment. After 48 h the cells looked almost completely damaged, and only fragments remained. Microvilli, blebs and ruffles, which indicate high surface activity and are characteristic morphological features of neoplastic astroglial cells in scanning electron microscopy, were severely disturbed by ALP incubation. Finally, the ability of tumor cells to adhere to glass and plastic surfaces was affected.

Computed Tomography and Magnetic Resonance Tomography of Intracranial Tumors

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Classification of Intracranial Tumors

L. Bruns (1914) stated in Krause’s “General Neurosurgery” that brain tumors included all neoplasms growing within the cranial cavity and that these might be divided into three groups: (1) genuine tumors, (2) granulomatous lesions, and (3) parasites. Current use of the term “brain tumor” is more precise and limited to the first of L. Bruns’ categories. Even so, brain tumors represent a large and inhomoge-neous group. The comparison and evaluation of such a diverse set of observations is only possible after making a systematic classification of pertinent data.

Computertomographie bei nicht tumorbedingten raumfordernden intrakraniellen Prozessen

Zahlreiche, nicht tumorbedingte raumfordernde intrakranielle Prozesse fuhren computertomo-graphisch zu tumorahnlichen Bildern. Die tumorspezifische Diagnose ist in vielen Fallen allein aus dem Computertomogramm kaum zu stellen. Selbst wenn alle klinischen Befunde bei der Beurteilung eines computertomogra-phischen Bildes herangezogen werden, konnen Fehlinterpretationen unterlaufen. Gerade im Hinblick auf die Indikation zu einem neurochirurgischen Eingriff und die Wahl des Operationsverfahrens ist aber eine moglichst exakte praoperative Artdiagnose erforderlich. Im Einzelfall mus also das gesamte Repertoire der klassischen Neuroradiologie ausgeschopft werden, um im Zusammenhang mit dem klinischen Krankheitsbild einen pathologischen computer-tomographischen Befund richtig einordnen und die entsprechenden therapeutischen Konsequenzen ziehen zu konnen.

Computertomographie bei Prozessen im Bereich der Schädelbasis und der Schädelkalotte

Zahlreiche CT-Scanner erlauben das Studium der knochernen Strukturen der Schadelbasis und der Schadelkalotte. Durch Wegfall einer Wasserbox und Vergroserung der Offnung der Gantry ist heute eine freie Lagerung des Kopfes des Patienten und damit die Abtastung sehr tiefer Schadelschichten ebenso wie eine coronare Schnittfuhrung moglich. Durch eine hochauflosende Matrix (z.B. 320 x 320 bei dem fur die meisten hier gezeigten Untersuchungen verwendeten CT-Scanner EMI 5005) wird ein sehr prazises Bild erzeugt.

Technique of CT Examination

The three study groups used the same CT systems during the investigation period : the EMI Mark I head scanner from 1975 until June 1977 and the EMI CT 1010 head scanner from the middle of 1977, with the Diagnostic Enhancement Package since March 1980. Special studies of the base of the skull were performed with an EMI CT 5005 body scanner (Department of Radiology, Klinikum Steglitz, Free Universityof Berlin).

Computed Tomography in Processes at the Base of the Skull and in the Skull Vault

Many CT systems allow detailed examination of the bony structures of the base of the skull and the vault. Elimination of the waterbox and enlargement of the opening of the gantry allows free positioning of the head, use of coronary projections, and studies of the base of the skull. A high-resolution matrix (320 × 320 for the EMI 5005 used in most of the studies in our series) provides a high degree of accuracy. A number of authors has reported on the use of computed tomography in studying the base of the skull, especially for planning surgical proce duresor radiation therapy (Liliequist and Forsell 1976; Bradac et al. 1977 b; Bradac et al. 1977c; Bradac et al. 1978; Hammerschlag et al. 1977; Caille et al. 1977; Lohkamp and Claussen 1977; Becker et al. 1978; Weinsteinet al. 1978; Huk and Schiefer 1978). The value and limitations of this technique in the diagnosis of lesions at the base of the skull and in the skull vault will be described in this chapter. Detailed discussions of individual histological tumor types are to be found under the appropriate headings elsewhere in the book.

Computed Tomography in Orbital Lesions

Lesions in the orbits are characterized by unilateral or bilateral proptosis and/or disorders of ocular motion. Before the advent of computed tomography diagnosis was made on the basis of conventional radiological studies of the skull and the orbits as well as with ultrasonog-raphy, fluorescence angiography, phlebography of the ophthalmic vein, and arteriograms of the internal and external carotid arteries. The introduction of CT has brought about a correspondingdecline in the use of invasive procedures (Wende et al. 1977).

Computertomographie bei Orbitaprozessen

Fur die Diagnostik von Orbitaerkrankungen, die durch einen ein- oder doppelseitigen Exophthalmus und/oder Storungen der Bulbusmotili-tat in Erscheinung treten, standen bisher neben den Rontgenaufnahmen des Schadels und der Orbita die Ultraschalluntersuchung, die Fluo-reszenzangiographie, die Angiographie der A. carotis interna und externa und schlieslich die Ophthalmica-Venographie zur Verfugung. Die Einfuhrung der CT hat die Bedeutung der invasiven Untersuchungsmethoden jedoch deutlich eingeschrankt (Wende et al. 1977).

Auswirkungen der Computertomographie auf den Untersuchungsablauf bei neurologisch-neurochirurgischen Erkrankungen

Die Computertomographie wird heute als die entscheidende und zuverlassigste Untersuchungsmethode fur den Nachweis von Hirntumoren angesehen. Mit ihr sind die intrakraniellen Geschwulste mit einer diagnostischen Genauigkeit von etwa 98% zu erfassen. Der auserordentliche diagnostische Wert der Computertomographie beruht dabei nicht nur auf dieser hohen Nachweisquote der Tumoren, sondern besonders auch auf ihrer Aussagekraft hinsichtlich Fragen der Artdiagnose eines Tumors, der Bestimmung der Lagebeziehungen zu lebenswichtigen Zentren, der Wachstumsart und der von den Geschwulsten ausgehenden raumfordernden Wirkung. So kann mit Hilfe der Computertomographie der gesamte Komplex „intra-kranieller raumfordernder Prozes“ auf einen Blick beurteilt werden.